Tales of drug addiction from the front line
● By J. Chambless
Mike Noone of the Chester County District Attorney's Office addresses Rep. Becky Corbin, Kerry Benninghoff and Chester County Rep. Eric Roe, among others, on April 6.
By John Chambless
The statistics were sobering, the
first-person accounts were harrowing, and the one thing that everyone
could agree on during a meeting of State Representatives on April 6
is that the drug problem in Chester County is bad and getting worse.
Rep. Becky Corbin (R-East Brandywine) and Kerry Benninghoff (R-Centre/Mifflin) presided over a meeting of the House Marjority Policy Committee held at the East Brandywine Township Building in Guthriesville that brought together state legislators from Chester County and as far away as Butler County, Pike County and Blair County. They all came to learn from those on the front lines of the opioid epidemic that has spread throughout Pennsylvania and the nation.
Opening the meeting, Benninghoff said that overdoses of opioids – often heroin laced with the powerful painkiller fentanyl -- are killing about 10 people every day in Pennsylvania. According to the Centers for Disease Control and Prevention, overdose deaths involving opioids have quadrupled in America since 1999. There are about 91 people in the United States dying every day from opioid overdoses. An untold number of others come close to dying.
Mike Noone was on the first panel to address the representatives. As the Chester County First Assistant District Attorney, he classified the drug crisis as “the number-one public health epidemic in this country right now. We are riding the crest of a wave that started a decade ago with over-prescription of painkillers. We are seeing the consequences of that perfect storm.”
Drug overdoses, he said, have recently taken over from car accidents as the leading cause of accidental deaths in the United States.
“No one ever woke up in the morning and said, 'I think I'll become a drug addict,'” Noone said. “They didn't go into a dark alley to buy drugs from a dealer. They got them from doctors, from their friends or family. It is estimated that about 90 percent of those addicted to opioids first got the pills as a prescription for pain management. Now, they're addicts.”
The worldwide production of oxycodone, for instance, was about 11.5 tons worldwide in 1998, Noone said. In 2013, it was 138 tons. “And those in the United States consume over 90 percent of that total,” he said.
For those who become addicted, the transition from prescription painkillers (which can cost $30 per pill on average) to cheap heroin is all too common. Heroin, Noone said, “is now the most dangerous illegal drug in the U.S.,” sold through dealer distribution networks that were set up in the 1980s to channel cocaine and other drugs into the country.
“Philadelphia is a distribution hub for heroin in the eastern United States,” Noone said. “It is not cocaine now. It's heroin and prescription pills.”
The airports, shipping ports and highways in the Philadelphia region make it an ideal place to import drugs and get them moved quickly, he explained.
Noone said he has walked along the train tracks in Kensington as part of his investigative duties. “It's like a third-world country,” he said of the place where the cheapest and purest heroin in the region is imported and consumed. “The closest thing I can compare it to is walking on a beach, only instead of sand, the ground is covered with heroin wrappers and needles.”
Also on the first panel was Coatesville Police Chief Jack Laufer III, who said, “It's obvious why Coatesville is represented here, but this epidemic knows no boundaries. It's not just a city problem. It impacts all communities. In Chester County, it's pervasive and it's everywhere.
“This is not a past generation's drug,” Laufer said of the new heroin. “The cutting agent for heroin is often fentanyl, which is 10 times more potent than morphine. It's not only dangerous for the user, it's dangerous for the officers who arrive at the scene of an overdose.”
Last year, 15 overdose deaths were avoided in Coatesville because every squad car is equipped with Naloxone, which, when administered in time, can reverse the effects of an opioid overdose and save a life.
Ethan Healey, who oversees the Naloxone program for Good Fellowship EMS in West Chester, said all 47 municipal police departments in the county got training in administering the drug, and 300 kits were distributed. “Last year it was used 165 times, and it saved the lives of 156 people,” Healey said. “The youngest person it was administered to was 17, and the oldest was 68. For Good Fellowship EMS, we see about one overdose a day.”
The drug is not a cure-all. If an overdosed person is allowed to wait too long, fentanyl can supress breathing and cause death. And Naloxone only reverses opioid overdoses, so if the overdose is caused by a mixture of drugs, the person may still die.
Naloxone is also available to the public, so tracking statistics for its use is difficult. Not all first responders are required to document if they use the drug on an emergency call. And the overlap between police departments and the Pennsylvania State Police means that overdoses can be missed in the record keeping.
Rep. Robert Lee James, of Manango and Butler counties, said the son of a friend of his died from an overdose of drugs purchased online from China. “There is a variety of drugs available online. This young man got the drugs in four days through the U.S. Mail,” James said. “They were labeled 'technology product.'”
Makers of synthetic opioid drugs can stay ahead of the law by altering one ingredient in the chemical makeup of a drug and selling it to buyers online.
Noone said that progress is being made with the medical community. “We've seen tremendous buy-in from doctors who realize that there was over-prescription going on,” he said. Now, better record keeping will flag buyers who try to get multiple prescriptions from different doctors in different areas. Fewer pills are given out at a time, reducing the possibility that they will be sold, or left to linger in medicine cabinets, where they are a lure to teens and others.
“Local and national law enforcement must work together to solve this,” Noone said.
He also recommended improvements in the process of taking an overdose victim from the emergency room and getting them directly into treatment. “There's a bit of a gap there now,” he said. “We need a system for a 'warm hand-off' of a person after Naloxone treatment, transitioning them to a care facility, not putting them back on the street.”
Overcrowded treatment programs mean that an addict can be delayed for weeks before being admitted, giving them time to fall back into using. For those addicted to heroin, even a few hours without using can lead to debilitating withdrawal symptoms, forcing them back to drugs.
Rep. Rick Saccone asked why drug dealers would cut heroin with a drug like fentanyl, which is so likely to cause death, and why addicts would choose it.
“For the addict, the more potent drug is the one you want,” Noone said. “They always think, 'Well it won't kill me this time.'”
In certain cases, “dealers are cutting fentanyl with a little bit of heroin, instead of the other way around,” Noone said. “In the mind of an addict, they want the highest high. But the reality is that the first high is the best, then it diminishes, forcing an addict to keep using just to avoid withdrawal.”
Harry Lewis, Jr., a representative from Downingtown/Coatesville, said that he drove through Coatesville on a recent warm day, “and there were all these young men standing around in one spot. Now, I know what's going on. I know, and you know, who these people are,” he said to Chief Laufer. “What can you do to get these people into the court system sooner?”
Laufer agreed that open-air drug sale areas are well known to local law enforcement, “but making arrests takes cooperation between the DA's office and local police,” he said. “There has to be funding for officers and equipment. We have to work within the U.S. Constitution to build cases that hold up in court, to assure that repeat offenders don't get released early. Once they are released, though,” he added, “there is a direct pipeline right back into the game once they are released from prison.”
A second panel addressed the legislators, highlighting issues of treatment for addicts.
“In the last eight years in Chester County, I have seen too many young people die,” she continued. “One of my son's friends is buried next to him. They went to childcare together.” Jackie Smiro, whose 17-year-old son, R.J., died from an overdose in 2008, recounted the horror of his death and her subsequent efforts through the Chester County NOPE (Narcotics Overdose Prevention and Education) task force. “R.J. had a problem with alcohol and prescription pills,” Smiro admitted, “but he never lived to get treatment. He died four months after his first attempt at rehab.
NOPE presents drug-prevention programs in middle schools and high schools that bring real people affected by the opioid epidemic up close to teens who may be experimenting with drugs. “When they come into the auditorium, they are sometimes saying, 'Oh, it's just another drug program,' but by the time they leave, they are very different,” Smiro said. “They walk out in tears. This is not a scare tactic. This is reality, told by actual parents who have lost children.”
Smiro said more after-school programs are needed for teens who are often alone before their parents get home from work. She also said that the scarcity of available treatment centers – and their cost – means that the 24-hour window for saving someone is often closed before treatment can begin.
“In my son's graduating class of 2009, we lost five to overdoses,” Smiro said. “We can't arrest our way out of this problem. We have schools that are expelling students and putting them into the prison system, and they're not going to get out.
“Rehabs are a revolving door. Some charge up to $10,000 per week,” she said. “So we're surprised when insurance companies won't pay for more than 10 days of treatment?”
Another panelist, Brandt Norton, now works with Behavioral Wellness and Recovery Treatment in West Chester, but said, “I was one of the statistics we've heard about today. I found prescription drugs at the age of 12. By 20, I was a full-blown heroin addict.
“I can't say exactly why I fell into addiction,” he said. “I just liked the effect of the drugs and alcohol. They made me feel like a whole person.”
Now clean and sober for seven years, Norton said he saw first-hand how a limited time in rehab will only put an addict back on the street, looking for drugs. In 2010, he finally committed to long-term treatment, “but after two weeks, the insurance company said, 'No more.'” he said. “I couldn't go home, because I was no longer welcome there. There was a recovery house in Philadelphia, but that was in the middle of a drug distribution center.”
His only choice was out-of-state treatment for 30 days, then a transition to a sober living community that worked. But it took five years of living out of state before Norton could return to mend fences with his family and begin to give back to the community by helping others escape addiction.
He suggested bridging the gap from overdose crisis to treatment by having a mobile crisis unit accompany police on overdose calls, working with addicts from the time they are in the hospital to get them into care, not back on the street.
“In Chester County, there are only two or three recovery houses,” Norton said. “There's an opinion that there's not a problem here. But I can say that if you find someone who's in recovery, you're looking at a miracle. I had no other option than to seek help or die. And I didn't want to die that day.”
For panelist Winden Rowe, her work as a therapist and counselor in Kennett Square came from a call her family got 11 years ago. Her husband's best friend had overdosed after getting sober for an extended time.
“In the life of a recovering person, shame is what you and I might experience – magnified exponentially,” she said.
Rowe explained how drugs affect the brain and ultimately rewire it to crave “liquid love” in the form of a drug that goes directly to pleasure centers, giving addicts a feeling of well-being that they otherwise cannot experience.
“I have heard horrific tales of abuse,” Rowe said. “We are talking about some of the most severely wounded people, and giving them a week or 10 days to address the biology of detox is not realistic.
“This is not a disease,” Rowe said. “This is a maladapted structure that has a lot to do with how we are as a society. I've seen doctors and nurses, lawyers and bankers, too many veterans to count, children, black and white, gay and straight – this problem is everywhere, and it's everyone. It hit my family. I hope it doesn't hit yours, but the odds aren't good.
“We are in the throes of a serious,
serious problem, and we are addressing it with Band-
Aids,” Rowe said. “I appreciate all the efforts of law enforcement and the judicial system, but we need to redirect the dialogue.”
For more information about the House Majority Policy Committee's work to combat addiction, visit www.PAGOPPolicy.com.
To contact Staff Writer John
Chambless, email firstname.lastname@example.org.